Basic Information
| Provider Information | |||||||||
| NPI: | 1811929359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIMAS COMMUNITY HOSPITAL, INC. | ||||||||
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| OtherOrganizationName: | SAN DIMAS COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57543 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263004122 | ||||||||
| FaxNumber: | 9095990629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 W COVINA BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917733245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095996811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARMIN | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT PROGRAMS, TENET | ||||||||
| AuthorizedOfficialTelephone: | 3107758043 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 93000039 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 95-3783605 | 01 | INTER VALLEY HEALTH PLAN | OTHER | 95-3783616 | 01 | WELLPOINT HEALTH NETWORKS | OTHER | 000410 | 01 | HUMANA | OTHER | 578531560 | 01 | AETNA US HEALTHCARE | OTHER | 95-3783606 | 01 | INTERPLAN | OTHER | 050588B000000 | 01 | SECTION 1011 | OTHER | 95-3783611 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | HSP40588G | 05 | CA | MEDICAID | X-0220213 | 05 | CA | MEDICAID | 005316-0001 | 01 | PACIFICARE OF CALIFORNIA | OTHER | 95-3783614 | 01 | TENET EMPLOYEES BENEFIT P | OTHER | HSC30588G | 05 | CA | MEDICAID | 199470000 | 01 | DEPT OF LABOR | OTHER | 8423 | 01 | HEALTH NET | OTHER | 95-3783607 | 01 | KAISER FOUNDATION HEALTH | OTHER | 95-3783608 | 01 | LOS ANGELES FOUNDATION FO | OTHER | 95-3783602 | 01 | BEECH STREET HEALTHCARE | OTHER | ZZZA2019Z | 01 | BS OF CALIFORNIA | OTHER |